1
|
Shao Z, Huang J, Feng H, Hu M. Optimizing the physical activity intervention for older adults with mild cognitive impairment: a factorial randomized trial. Front Sports Act Living 2024; 6:1383325. [PMID: 38774280 PMCID: PMC11106430 DOI: 10.3389/fspor.2024.1383325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 04/15/2024] [Indexed: 05/24/2024] Open
Abstract
Background Physical activity (PA) intervention is one of the most effective interventions to promote cognitive function of older adults with mild cognitive impairment (MCI). However, the level of PA remains low. Based on the two core interventions (X-CircuiT and health education), this study aimed to examine the effect of three implementation strategies (viz., role modeling, goal-setting, and reminding) on the PA level among older adults with MCI using the multiphase optimization strategy (MOST). Methods Participants were randomized into one of eight conditions in a factorial design involving three factors with two levels: (i) role modeling (on vs. off); (ii) goal-setting (on vs. off); and (iii) reminding (on vs. off). The primary outcome was PA level at 12 weeks. The secondary outcomes were cognitive function, self-efficacy, and cost-effectiveness at 12 weeks. The intention-to-treat (ITT) analysis was performed as the main analysis and the per-protocol (PP) analysis as the sensitivity analysis. Results A total of 107 participants were included and randomly assigned into three groups, each receiving different implementation strategies. The results of the multivariate regression analysis showed that the three implementation strategies, namely, reminding (B = 0.31, p < 0.01), role modeling (B = 0.21, p < 0.01), and goal-setting (B = 0.19, p < 0.01), could significantly improve PA level. Specifically, it was found that role modeling (B = 0.68, p = 0.03) could significantly improve cognitive function. There were no significant interactions among the three implementation strategies. Role modeling was the most cost-effective strategy, costing 93.41 RMB for one unit of PA. Conclusions Role modeling was likely to be the best implementation strategy. The value-based and cost-effective PA intervention package could include the core intervention (X-CircuiT and health education) and implementation strategy (role modeling). Clinical Trial Registration https://www.chictr.org.cn, The study was retrospectively registered on 30 June 2022 (ChiCTR2200061693).
Collapse
Affiliation(s)
- Zhanfang Shao
- Department of Nursing, Peking Union Medical College Hospital, Beijing, China
| | - Jundan Huang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Hui Feng
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Mingyue Hu
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| |
Collapse
|
2
|
Chang KH, Wang C, Nester CO, Katz MJ, Byrd DA, Lipton RB, Rabin LA. Examining the role of participant and study partner report in widely-used classification approaches of mild cognitive impairment in demographically-diverse community dwelling individuals: results from the Einstein aging study. Front Aging Neurosci 2023; 15:1221768. [PMID: 38076542 PMCID: PMC10702963 DOI: 10.3389/fnagi.2023.1221768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/29/2023] [Indexed: 01/28/2024] Open
Abstract
Objective The role of subjective cognitive concerns (SCC) as a diagnostic criterion for MCI remains uncertain and limits the development of a universally (or widely)-accepted MCI definition. The optimal MCI definition should define an at-risk state and accurately predict the development of incident dementia. Questions remain about operationalization of definitions of self- and informant-reported SCCs and their individual and joint associations with incident dementia. Methods The present study included Einstein Aging Study participants who were non-Hispanic White or Black, free of dementia at enrollment, had follow-up, and completed neuropsychological tests and self-reported SCC at enrollment to determine MCI status. Informant-reported SCC at baseline were assessed via the CERAD clinical history questionnaire. Self-reported SCC were measured using the CERAD, items from the EAS Health Self-Assessment, and the single memory item from the Geriatric Depression Scale. Cox proportional hazards models examined the association of different operationalizations of SCC with Petersen and Jak/Bondi MCI definitions on the risk of dementia, further controlling for age, sex, education, and race/ethnicity. Time-dependent sensitivity and specificity at specific time points for each definition, and Youden's index were calculated as an accuracy measure. Cox proportional hazards models were also used to evaluate the associations of combinations of self- and informant-reported SCC with the risk of incident dementia. Results 91% of the sample endorsed at least one SCC. Youden's index showed that not including SCC in either Jak/Bondi or Petersen classifications had the best balance between sensitivity and specificity across follow-up. A subset of individuals with informants, on average, had a lower proportion of non-Hispanic Blacks and 94% endorsed at least one self-reported SCC. Both informant-reported and self-reported SCC were significantly associated with incident dementia. Conclusion Our findings suggest that the SCC criterion may not improve the predictive validity for dementia when included in widely-employed definitions of MCI. Consistent with some prior research, informant-reported SCC was more related to risk of incident dementia than self-reported SCC. Given that requiring informant report as a diagnostic criterion may unintentionally exclude health disparate groups, additional consideration is needed to determine how best to utilize informant-report in MCI diagnosis.
Collapse
Affiliation(s)
- Katherine H. Chang
- Department of Psychology, Queens College, City University of New York (CUNY), Queens, NY, United States
- Department of Psychology, The Graduate Center, City University of New York (CUNY), New York, NY, United States
| | - Cuiling Wang
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Caroline O. Nester
- Department of Psychology, Queens College, City University of New York (CUNY), Queens, NY, United States
- Department of Psychology, The Graduate Center, City University of New York (CUNY), New York, NY, United States
| | - Mindy J. Katz
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Desiree A. Byrd
- Department of Psychology, Queens College, City University of New York (CUNY), Queens, NY, United States
- Department of Psychology, The Graduate Center, City University of New York (CUNY), New York, NY, United States
| | - Richard B. Lipton
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, United States
- Department of Psychiatry and Behavioral Medicine, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Laura A. Rabin
- Department of Psychology, Queens College, City University of New York (CUNY), Queens, NY, United States
- Department of Psychology, The Graduate Center, City University of New York (CUNY), New York, NY, United States
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, United States
- Department of Psychology, Brooklyn College, City University of New York (CUNY), Brooklyn, NY, United States
| |
Collapse
|
3
|
Lin LH, Wang SB, Xu WQ, Hu Q, Zhang P, Ke YF, Huang JH, Ding KR, Li XL, Hou CL, Jia FJ. Subjective cognitive decline symptoms and its association with socio-demographic characteristics and common chronic diseases in the southern Chinese older adults. BMC Public Health 2022; 22:127. [PMID: 35042501 PMCID: PMC8767737 DOI: 10.1186/s12889-022-12522-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 01/03/2022] [Indexed: 11/10/2022] Open
Abstract
Background Subjective cognitive decline (SCD) may be the first symptomatic manifestation of Alzheimer’s disease, but information on its health correlates is still sparse in Chinese older adults. This study aimed to estimate SCD symptoms and its association with socio-demographic characteristics, common chronic diseases among southern Chinese older adults. Methods Participants aged 60 years and older from 7 communities and 2 nursing homes in Guangzhou were recruited and interviewed with standardized assessment tools. Pittsburgh Sleep Quality Index (PSQI), Patient Health Questionnaire–9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) were used to measure poor sleep quality, depression symptoms and anxiety symptoms. The SCD symptoms were measured by SCD questionnaire 9 (SCD-Q9) which ranged from 0 to 9 points, with a higher score indicating increased severity of the SCD. Participants were divided into low score group (SCD-Q9 score ≤ 3) and higher score group (SCD-Q9 score > 3). Chi-square tests and multivariate logistic regression analysis were used for exploring the influences of different characteristics of socio-demographic and lifestyle factors on SCD symptoms. Univariate and multivariate logistic regression analysis were applied to explore the association between SCD symptoms with common chronic diseases. Results A total of 688 participants were included in our analysis with a mean age of 73.79 (SD = 8.28, range: 60–101), while 62.4% of the participants were females. The mean score of the SCD-Q9 was 3.81 ± 2.42 in the whole sample. A total of 286 participants (41.6%) were defined as the low score group (≤3 points), while 402 participants (58.4%) were the high score group (> 3 points). Multivariate logistic regression analysis revealed that female (OR = 1.99, 95%CI: 1.35–2.93), primary or lower education level (OR = 2.58, 95%CI: 1.38–4.83), nursing home (OR = 1.90, 95%CI: 1.18–3.05), napping habits (OR = 1.59, 95%CI: 1.06–2.40), urolithiasis (OR = 2.72, 95%CI: 1.15–6.40), gout (OR = 2.12, 95%CI: 1.14–3.93), poor sleep quality (OR = 1.93, 95%CI: 1.38–2.71), depression symptoms (OR = 3.01, 95%CI: 1.70–5.34) and anxiety symptoms (OR = 3.11, 95%CI: 1.29–7.46) were independent positive related to high SCD-Q9 score. On the other hand, tea-drinking habits (OR = 0.64, 95%CI: 0.45–0.92), current smoking (OR = 0.46, 95%CI: 0.24–0.90) were independent negative related to high SCD-Q9 score. Conclusions Worse SCD symptoms were closely related to common chronic diseases and socio-demographic characteristics. Disease managers should pay more attention to those factors to early intervention and management for SCD symptoms among southern Chinese older adults.
Collapse
|